ASK DR. BAUGHAN                                             February  4, 2000

FEVER DEJA VU

The very first column I wrote for this paper dealt with fevers in children and when they need medical attention.  About two years later I reviewed the topic.  Well, a new crop of young parents has come along who somehow did not receive laminated copies of those columns at their baby showers, because once again the weekend doc on call is besieged with calls about young-uns with mid-winter fevers.  So I get to feel a little older and crotchety, and after five years of writing this column, will ask your tolerance if I largely repeat one from three years ago.

When is a fever dangerous in and of itself?  Two key situations to remember: (1) If an infant is less than two months old and has a fever over 101.3 degrees rectally, it should be evaluated promptly.  Most of these babies will have a virus that may not require treatment, but about 5% of them may have a blood-stream infection that could get serious quickly.  (2) If a fever is 106 degrees and over, the height of the temperature can cause harm to the nervous system, and the likelihood of a blood-stream infection is higher.

The medical classifications of fevers would be:  101.5 - 103 degrees, mild fever; 103-105 degrees, moderate fever: over 105 degrees, high fever.  A child with a fever of 103 degrees in the middle of the night may feel like he or she is “burning up,” but the height of the temperature does not always indicate how sick the child is.  Any of the 100+ cold and flu viruses can cause fevers of 103-105.

“My child had a fever.  I have Tylenol (or ibuprofen) and it’s not coming down.  What do I do next?”  Shift focus from the temperature to the child.  How does the child look?  Generally miserable, or any specific symptoms?  Is the child breathing all right?  Is the child drinking liquids OK?  Has the child had more than 5 separate loose stools?  Is the child rag-doll limp and not responding?  Does the child have a rigid neck?  The answers to these questions help decide if the child needs to be seen emergently, or can the parents safely observe at home?  If the child is otherwise free of symptoms (or has typical cold symptoms), the fever will be uncomfortable, but not dangerous, so it is best to ride it out, give medicines at the next interval, or try a cool bath.  Similarly, if the fever comes down, but goes back up when the medicine wears off, this is not a sign of a complication.

“Suppose the fever is from an ear infection or a strep throat.  How soon should I start my child on antibiotics?”  The antibiotics will take at least 24 hours, usually more like 48 hours, before they reduce the fever.  So even if we could immediately begin treatment, the child and parent are likely to have several tough nights.  The chances of those infections causing complications in the first 2-3 days is extremely remote.  Remember, the key reason for treating strep is to protect the heart and kidneys from complications of strep:  this protection can occur if antibiotics are started 7-10 days later!

We all hat to see our kids suffer with an illness.  We want them better instantly.  It is a humbling (and frustrating) profession that requires doctors to explain our limits - we cannot make kids feel better as quickly a we would wish.  Hopefully, we can educate and reassure parents about when urgent action is needed, and when patience and TLC are the best medicines.